Abstract

Development of 3-D models of human anatomy for use in virtual reality simulators is anticipated to enhance surgical training. These models may be a valuable resource for gaining mastery of minimal-access procedures. The pelvis portion (hip to upper-thigh) of a 32-year-old female cadaver was frozen and sectioned axially in approximately 2-mm increments as the first step in producing an accurately representative 3-D model of the human female pelvis. Photographic exposures of the entire series of 95 sections were then converted to digital format. Adobe PhotoShop masks for each structure were created and converted into wire-frame and surface-textured models; this aggregate model set was named "LUCY." To date, 3-D representations of 40 pelvic structures (over 2200 individual masks) have been modeled In conjunction with haptic technology, these virtual anatomic models will enable users to practice fundamental surgical manipulations and procedures such as tubal ligation and ovariectomy. The deployment of surgical-simulation models such as LUCY may facilitate technical-performance aspects of surgical training, particularly those associated with minimal-access procedures. Manipulations and procedures can be practiced over the Internet, providing a host of flexible options to enhance the surgical curricula.

Abstract

The present state of human gross anatomy in medical education can generally be characterized as the presentation of a large bolus of information that is swallowed and only partly digested during the first year of medical school. The subject is often taught in a depth beyond that which would be relevant to all physicians irrespective of their future professional careers. This condition has resulted from adaptive adjustments to the escalating discrepancy between a rapidly expanding knowledge base in science and technology and the relatively fixed time period for education of a physician. Initially, traditional courses retained their comprehensive character, and new information was simply piled on top of existing departmental offerings. It soon became obvious that there would have to be a reduction in time devoted to established courses and a reciprocal expansion of time to accommodate newly developing sciences. Such adjustments were painful and often led to conflicts about what comprises essential knowledge in medical education. Thus, the curriculum time devoted to human gross anatomy has been significantly reduced to accommodate new knowledge in cellular and sub-cellular structures and other disciplines. That common foundation of knowledge, skills, values, and attitudes essential to all physicians regardless of specialty is ever-changing and often debated by medical school faculty members. However, two facts are generally agreed upon: that today's medical student with a broad but perhaps thin base in science and limited direct clinical experience is not competent upon graduation to assume patient care responsibilities without supervision and that as a result, the formal education of a physician has expanded into the graduate domain.(ABSTRACT TRUNCATED AT 250 WORDS)

Abstract

The transfer of autogenous tissues in man has its origins in antiquity. Movement of composite tissues using pedicle techniques, which assured that such tissues were never deprived of vital blood supply, preceded free grafting. The ultimate refinement of carrying pedicles was reached in the vascularized island pedicle flap, which carried composite tissues solely on an intact vascular leash. An enormous increase in the versatility of composite transfers occurred when microvascular surgery made transfer with immediate vascularization a reliable procedure. This opened the door to free functioning muscle and musculocutaneous transfers with motor reinnervation at the recipient site--the supreme tissue transfers.

Abstract

This review recounts the known historical development of techniques to achieve soft tissue coverage using free skin grafts, pedicle flaps of various types, and composite tissue transfers with immediate revascularization. There is documentation of an incremental emphasis on muscle-containing pedicle flaps and free revascularized composite tissue transfers in the world literature.

Abstract

The major criticism of all medicine today is spiraling cost of health care. This is fanned in intensity by economists, politicians, and social scientists who add up the costs, which, in fact, have skyrocketed, and they have concluded that it "isn't worth it." The major basis for that conclusion is that despite the fact that health care costs are gobbling up 11% of the gross national product (+189 billion), there has been an increase in life expectancy of only 1 year. Use of life expectancy as the outcome measure is simple-minded, misleading, and inappropriate, and it is used only because the objective data are clear-cut and available. Mortality is a clear endpoint. Some of the greatest advances in medicine and all of those in the field of hand surgery have nothing to do with duration of survival (quantity of life), but contribute with major impact to the productivity, adjustment, and self-satisfaction of patients (quality of life). We have the opportunity to challenge and counter some of the adverse public image that is the current portrait of all of medicine. Much of that image is based on flimsy, inaccurate data that are extrapolated into gross untruth by nonmedical, short-sighted adversaries. Hand surgeons must collect objective evidence of the rehabilitation benefits of hand surgery care to persons suffering deformity and associated disability. Such data may be extrapolated to show the true cost-risk-benefit ratios produced by hand surgeons.

THE TREATMENT OF CONTRACTURES OF THE HAND USING SELF-HYPNOSISJOURNAL OF HAND SURGERY-AMERICAN VOLUMESpiegel, D., Chase, R. A.1980; 5 (5): 428-432

Abstract

The successful treatment of a man with severe posttraumatic contractures of the hand using a combined psychological and physical rehabilitation approach is reported. The contractures had functional and organic components, as did the treatment, which involved teaching the patient self-hypnosis exercises and the use of a splint. The patient obtained virtually complete return of movement after 3 1/2 years of total disability. The importance of identifying and mobilizing rather than challenging the patient's motivation for recovery using a rehabilitation approach is discussed. Hypnosis can facilitate recovery in such psychosomatic disorders in patients with the requisite hypnotic capacity and motivation.

Abstract

Relocation of functional units by neurovascular pedicle transfer is firmly established in reconstructive hand surgery. Transfer of muscle and overlying skin, the myocutaneous flap, to provide skin cover is equally established. The dynamic myocutaneous flap is an extension of these concepts. Injection studies confirmed that the abductor digiti quinti muscle and its overlying hypothenar skin could be transferred on its neurovascular bundle. This dynamic myocutaneous flap was used to reconstruct both skin cover and functional opposition following resection of an arteriovenous malformation involving the thumb. Other clinical applications would include reconstruction of thenar skin and muscle lost secondary to electrical burns, avulsion, or tumor resection.

Abstract

Over the past half decade, there has been an increment in forces moving the profession toward recertification and a decrement in the restraining forces. The whole process will be catalyzed by available funding through grants to implement continuing medical education, development of performance-, and competency-based assessment measures and recertification. Specialty boards serving relatively small numbers of candidates have serious difficulty funding certification, to say nothing of recertification. An adequate mechanism to implement recertification can emerge only from the profession itself, working through the American Board of Medical Specialties and specialty boards. The means to discharge this responsibility should, at the outset, come from public and private sources. Eventually the system may become self-supporting through evaluation and certification fees. The public interest will be best served when there are adequate mechanisms to assess continuing competence of all physicians. As a minimum, there must be a system to guard against incompetence through obsolescence of any of the practicing professionals.

Abstract

The silicone inlay method of prefabricating subcutaneous and bony implants for congenital and acquired defects of the maxillofacial area was used in 25 cases. Heat vulcanized Silastic 372 or 373 was used, and seems to be satisfactory. The method is presented as a useful addition to the surgical restoration of subcutaneous and bony defects, particularly complex contours of the periorbital area when autogenous tissue is unavailable. Complications seem to be less common when the implant is immobile and secured to bone. The method is evolving, and modifications can and should be made in the technique.